Friday, September 12, 2008

HEALTH NEWS: Diabetes Before Pregnancy Linked To Birth Risk

A study from the U.S. Centers for Disease Control and Prevention (CDC) reported that women with diabetes prior to becoming pregnant are eight times more likely to have children with multiple birth defects compared to women without diabetes.

The study found also that women with diabetes are three to four times more likely to give birth to a baby with at least one birth defect.

Women with pregnancy-induced diabetes, or gestational diabetes, were also found more likely to have a child with a birth defect, although usually only if they were overweight or obese at conception. This range would mean a body mass index (BMI) - weight measured in proportion to height - of 25 or higher.

The study expanded on previous research by examining women with type 1 and type 2 diabetes as well as gestational diabetes, and considering both cardiac and non-cardiac defects, nearly 40 in all.

Only 2 percent of babies with single birth defects and 5 percent with multiple defects were born to mothers with pre-pregnancy diabetes, while 93 percent of the birth defects examined were not associated with maternal diabetes.

Overall, diabetes diagnosed before pregnancy was linked with about half of the birth defect categories examined.

Birth defects may include heart problems, brain and spinal defects, oral clefts, limb deficiencies, and kidney and gastrointestinal tract defects. These affect 1-in-33 infants and are a leading cause of infant death, according to the CDC. Most causes are unknown.

The findings were based on data analyzed from over 13,000 infants with birth defects and nearly 5,000 without defects, all born between 1997 and 2003. Of those without defects, 24 mothers had diabetes before diabetes. Of those newborns with defects, 283 mothers had pre-pregnancy diabetes.

All children were part of the National Birth Defects Prevention Study, which drew data from 10 birth-defect surveillance systems in 10 states.

However, according to Janis Biermann, a spokeswoman for the March of Dimes which reviewed the study for WebMD, women shouldnotbe unduly concerned.

"Just because there is an increased risk of a baby having a birth defect if a woman has preconception diabetes doesn't mean it is going to happen," she said, "It just means there is a greater chance than if a woman doesn't have it."

The study is the largest yet done to identify the range of birth defects linked to pre-pregnancy diagnoses of diabetes, but the link itself has been known for almost two decades. Researchers hope that increased awareness will encourage people to seek the best available everyday preconception care.

"Early and effective management of diabetes for pregnant women is critical in helping to not only prevent birth defects, but also to reduce the risk for other health complications for them and their children," said lead author Dr. Adolfo Correa, an epidemiologist at the CDC's National Center on Birth Defects and Developmental Disabilities, in a news release.

According to the March of Dimes, about 1.85 million U.S. women of childbearing age have diabetes.

"The most important thing is that the patient ... get [her diabetes] in control," said Dr. Louis Weinstein, M.D., professor and chairman of OBGYN at Thomas Jefferson University.

In an urban area such as Philadelphia, "we tend to see more diabetes than in other parts of the country because we have lower socioeconomic populations with higher BMI [levels] than elsewhere," Dr. Weinstein added.

"It's important to take care of yourself, exercise, be at an optimal weight, plan your pregnancy, and make sure the diabetes is well controlled before you get pregnant," Ms. Biermann, from the March of Dimes, said to WebMD.

Once pregnant, Ms. Biermann notes the importance of following the same healthy habits and having regular prenatal care, along with regular appointments with a diabetes specialist for those diagnosed.

The report was published this month in the American Journal of Obstetrics & Gynecology.